Reattachment techniques of soft tissue to bone employing knotless fixation devices are known in the art, particularly for the formation of single and double row constructs in arthroscopic rotator cuff repairs. For example, the SpeedFix™ and SpeedBridge™ techniques, both developed by Arthrex, Inc., use a threaded swivel anchor, such as Arthrex SwiveLock® C anchor (disclosed and described in U.S. Pat. No. 8,012,174) combined with FiberTape® (disclosed in U.S. Pat. No. 7,892,256) to create a quick and secure SpeedFix™ construct (a knotless single row repair) or a SpeedBridge™ construct (a knotless double row repair) with no knots and very few suture passing steps.
In the SpeedBridge™ technique, a swivel anchor (preferably an Arthrex 4.75 mm SwiveLock® C anchor) loaded with one strand of FiberTape® is inserted into a medial bone socket. A FiberLink™ and Scorpion™ shuttle both FiberTape® tails through the rotator cuff simultaneously. Next, one FiberTape® tail from each medial anchor is retrieved and loaded through another SwiveLock® C eyelet. The loaded eyelet is inserted into a prepared lateral bone socket until the anchor body contacts bone, and the tension is adjusted if necessary. The SwiveLock® C driver is rotated in a clockwise direction to complete the insertion. Using an open ended FiberWire® cutter, the FiberTape® tails are cut to complete the technique.
The above-described SpeedFix™ and SpeedBridge™ suture bridge techniques restore the anatomic footprint and are particularly suitable for rotator cuff tears which usually occur at the tendon-bone insertion. However, at times, a tear can occur more medially or be accompanied by lateral tendon loss, precluding the ability to perform a double row repair. “Rip-stop” suture configurations have been shown to improve load to failure compared with simple or mattress stitch patterns. C. B. Ma et al., “Biomechanical evaluation of arthroscopic rotator cuff stitches,” J Bone Joint Surg Am, Vol. 86, pp. 1211-1216 (2004). As described in the Ma publication, a rip-stop suture may be placed as an isolated suture or with the use of a double- or triple-loaded anchor. In the case of an anchor, the first set of anchor sutures are used to create a mattress stitch and the remaining sutures are passed medial to lateral in a simple pattern. A rip-stop suture with a double-loaded anchor has a load to failure equivalent to a modified Mason-Allen stitch. In a follow-up study, it was reported that a triple-. loaded anchor with a horizontal rip-stop stitch and two simple stitches demonstrate even less elongation with cyclic loading (i.e., maintained loop security) and a higher ultimate load to failure compared to the rip-stop configuration with a double-loaded anchor. M. Baleani et al., “Comparative study of different tendon grasping techniques for arthroscopic repair of the rotator cuff,” Clin Biomech (Bristol, Avon), Vol. 21, pp. 799-803 (October 2006). Notably, the highest load to failure is achieved with a classic double-row repair.
Accordingly, a new surgical technique for double row constructs with a reinforced medial row (especially for rotator cuff repairs with lateral tendon loss), using a “rip-stop” suture pattern, is needed.